title: The role of ultrasound as an adjunct to arterial catheterization in critically ill surgical and intensive care unit patients.
abstract: OBJECTIVE
  To review the evidence behind Ultrasound (US) guided placement of arterial cannulae and its use in the critically ill population.
  
  
  METHODS
  We performed a computer-aided literature search using set search terms and electronic data bases of PubMed and EMBASE from their commencement date through the end of July 2013.
  
  
  RESULTS
  Insertion of intra-arterial catheters is a commonly performed invasive procedure in the peri-operative and intensive care setting that facilitates invasive blood pressure and cardiac output monitoring as well as frequent blood sampling. Arterial catheterization can be particularly challenging in critically ill and high-risk surgical patients with circulatory collapse, low cardiac output state and peripheral edema, all of which can limit the ability to successfully palpate and cannulate the artery. There is a convincing body of evidence suggesting a decrease in complication rate and first-pass success rate in US guided central venous catheter (CVC) insertion compared with the landmark technique. While most intensivists and peri-operative physicians are familiar with US guided CVC placement, fewer use US to guide arterial access.
  
  
  CONCLUSIONS
  Most studies have demonstrated a higher success rate when using US guidance for arterial cannulation. Moreover, the technique permits more rapid access and establishment compared with the conventional palpation technique. However, there is evidence opposing the routine use of US to guide arterial cannula insertion. Further studies are required to ascertain the benefits and cost effectiveness of US guided arterial catheterization in peri-operative and critical care.
authors.affiliation: Cardiac Intensive Care Unit, Papworth Hospital NHS Trust, Papworth Everard, Cambridge - UK.
authors.forename: Vasileios A
authors.initials: VA
authors.lastname: Zochios
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wilkinson
authors.forename: Kausik
authors.initials: K
authors.lastname: Dasgupta
mesh_terms: D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002302:Cardiac Output; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic / Q000009:adverse effects / Q000379:methods*; D019990:Perioperative Care / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers